Newer antibiotics for the surgeon

Abstract

It is an honor for me to have been asked by Dr. Ronald Elkins and the Program Committee to deliver the 21st Annual Thomas G. Orr Memorial Lecture. Dr. Orr was born in 1834 and was an Alpha Omega Alpha graduate of Johns Hopkins University in 1910. Among his many ,accomplishments, he was a founding member of the American Board of Surgery, president of the Western Surgical Association, the second president of the Southwestern Surgical Congress, and president of the American Surgical Association. For 25 years, he was professor and chairman of the department of surgery at the University of Kansas, where he was also professor of bacteriology. As professor of bacteriology, I am sure that Dr. Orr would be amazed today to see the number and spectrum of newer antibiotics. A survey of 1 million hospital admissions to 338 hospitals determined that 42 percent were surgical admissions; however, these patients accounted far 71 percent of nosocomial infections [I]. The annual cost of nosocomial infections exceeds 1.5 billion dollars [2]. Preoperative antibiotics are usually administered to patients undergoing elective operations after arrival in the operating room. Animal studies demonstrate that wound infections are related to the time from contamination of a wound or incision until the administration of an antibiotic. The longer the delay from contamination until antibiotic administration, the greater the inflammatory response [3]. Several factors must be considered when comparing newer antibiotics, including pharmacologic properties, cost, in vitro activity, toxicity, and clinical efficacy. The longer the half-life, the less frequent the dosing. Less frequent administration means decreased cost due to less nursing and pharmacy time required to mix and administer the antibiotic, using fewer intravenous infusions. A true